Diabetic Home Care and Monitoring (cont.)

Robert Ferry Jr., MD

Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Hemoglobin A1C (HbA1c) testing

The hemoglobin A1c test (HbA1c) is crucial to monitor blood glucose control in patients with diabetes. In brief, hemoglobin A1c is the final product of several chemical reactions that occur in the bloodstream as red blood cells are exposed to glucose. A red blood cell typically lives for about three months, so the HbA1c reading provides a report card averaging blood sugar levels over the prior three months. Many different methods are available to determine the HbA1c level. Regardless, HbA1c level has been shown to predict the risk for developing complications of diabetes, much in the same way that cholesterol levels are predictive of heart disease. The HbA1c test should be performed routinely at three-month intervals in patients with established diabetes. HbA1c can be tested when a new case of adult diabetes is suspected, although its use to diagnose borderline pediatric diabetes is still controversial.

To measure HbA1c, blood obtained in the usual way (from a vein) can be sent to a laboratory. Alternatively, many clinics specialized in diabetes care now have desktop HbA1c machines, which will read a simpler fingerstick blood sample within minutes. Several conditions can affect HbA1c measurements, and most relate to disorders of the red blood cells. For example, results may be falsely low if too few red cells are present (anemia). Falsely low readings can occur when red blood cells lose their proper shape (due to conditions like thalassemias, sickle cell disease, or spherocytosis). HbA1c is invaluable as a tool to individualize patient care plans so that glycemic goals can be achieved.